Provider Demographics
NPI:1093195778
Name:CORONADO, REBECCA C
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:CORONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:D
Other - Last Name:CASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5144 REYNOSA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2735
Mailing Address - Country:US
Mailing Address - Phone:314-322-0693
Mailing Address - Fax:636-464-5438
Practice Address - Street 1:5144 REYNOSA DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2735
Practice Address - Country:US
Practice Address - Phone:314-322-0693
Practice Address - Fax:636-464-5438
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37402235Z00000X
IL146016907235Z00000X
MO2016013143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist